San-Fran

In San Francisco for a 'free day' where we are allowed to do whatever we want. There are only two of these on this holiday (until I get to Hawaii) and this lack of freedom annoys me somewhat.

Speaking of Hawaii, Mother Earth was a bit previous in throwing a hurricane at it as I'm not there for a few days, so that'll count as a miss then.

In SF we seem to be staying in a fair rough part of town, there are a lot more homeless than I see in London – five or six on each street corner here. I'm guessing that this is the 'American Dream' that we hear so much about.

I also saw the the instance of emergency aid here. It started off with a huge fire truck racing through the streets – I then turned the corner and saw them treating someone at the site of a car crash. Well, I say 'car crash', but it wasn't even a fender-bender. There was a tiny mark on one of the bumpers of the cars, no damage to either vehicle.

But for some reason they had 'collared' the patient and was holding her head as if she had been in a 40 mph head-on collision. I didn't hang around to see if they were going to cut the top of the undamaged car off – I also thought that they wouldn't appreciate my advice, so I kept walking. It all seemed a bit of an over-kill although I don't know how the services work out here.

My guess would be that a 'proper' ambulance would turn up and take the collar off and walk the patient into the back of the ambulance, it's most likely what I'd do.

American TV news is also insane – the anchor's teeth eerily follow you around the room, and one of the main stories yesterday was about a dog with air conditioning in it's kennel. Thankfully I've been able to get onto the BBC news site. Sad news about the two year old stabbed to death on my patch. I am also hearing rumours about a local ambulance crew who saved a woman and child from a burning building – well done gentlemen, you deserve a commendation.

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15 thoughts on “San-Fran”

The fire truck showed up because most American paramedics are part of the local fire department (especially in big cities), and the fire truck crew stabilize the wreck and do most of the clean-up work. Also, for some reason the fire trucks seem to be able to go faster than ambulances, so they can show up sooner.The collar prevents lawsuits later. No need to feed the lawyers.

No, we don't have good news. I prefer to watch BBC News, except when they hit one of my bias sensitivities, and then I start itching to turn the channel.

The Woo-woo's (firemen) always seem to get there before us as well. Perhaps because they are in their rack snoozing while we are just clearing another call???Only doctors can clear a c-collar here..and the reason is exactly as stated above, “No need to feed the lawyers any extra”.

Hi, newham was on Panorama last night as well, about street gangs. I had the bizarre experience of reading about it in your blog at the same time as watching it on tv…Very sad about the 2 year old – that sort of thing is just beyond comprehension.

welcome to enidd's new home town! she wonders if the poor area of town you're staying in might be the one she's living in – the mission district?the chronicle did a special on the homeless – it's well worth a read: http://sfgate.com/homeless/

The thing about the homeless in San Francisco, is that they seem more genuinely broken than the homeless I've seen in other cities. Based on purely anecdotal evidence, there seems to be a much higher concentration of the mentally ill.

The biggest reason why there are so many homeless in SF is that SF has the most liberal guidelines for public welfare qualification of any city in America. The city is largely financed by taxes from high-techs, which explains the ridiculously high rents and housing prices, too, as the workers of these companies are making loads of cash. However the extra money is pretty much given away, so all manner of homeless/ homeless-mentally ill move to SF and immediately get on the welfare rolls. Can you blame them?There is no way any city could have this huge transfer-of-wealth without the wealth, and Silicon Valley supplies it. It's that wealth that also drives up the prices of things, contributing to the problems the “underclasses” already have. That's the crazed dynamic at work.

Oh yeah, another factor: SF does not enforce laws around marijuana possession or prostitution. Basically it's like hanging a giant “Come here, we love you!” sign for every druggie and streetwalker in the country. Other American cities are, believe me, much better-representative of the typical American situation than SF. SF is, it's fair to say, utterly unique in the American city-scape.

Feeling deeply ashamed of our tv news (which IS horrible), I tuned into BBC world news for the first time in a while and was treated to an ABBA retrospective. It looks like you're becoming more like us every day….

We only cut up the car if it is impossible to remove the patient any other way. We're pretty good at getting people out of cars and onto boards through the doors.We do have a fair amount of leeway concerning boarding and collaring. While MOI certainly plays into the decision, the patient condition is more important as far as I can tell. Certainly in the more rural areas, practitioners are more familiar to the MDs and therefore have more trust from the doctors. Still, local protocols and standards have precedence. I attended an accident in Dallas (http://bxiieq.wordpress.com/2007/03/12/welcome-to-dallas/) where I thought the patient I was looking after (as a passerby) deserved a board and collar; the FD pulled the patient out of the car without c-spine precautions. I prefer not to board patients unless I have a high degree of suspicion or I find myself figuring out how to explain to the 'A&E' why I didn't board a given patient.

My guess would be: the collar is in place because the victim complained about a severe pain in the neck, hoping to boost up her compensation later (apparently, a collar is a wonderful tool to get more money this way)!!So it would indeed be a case of laywer frenzy, but not one directly involving the emergency services!Although of course, I don't know the answer to this question: if you had to rescue someone who complained about pain in the neck after a “car crash” (however small and insignificant), would you necessarily collar them?